Male circumcision first, doctors and nurses second (or not at all): talk about the cart before the horse!

While the press is running around in circles trumpeting male circumcision as the breakthrough we’ve been waiting for, Africa goes on bleeding. Mark Dybul, the Global AIDS Coordinator for the US Department of State, has remarked that it takes some 200 circumcisions before a practitioner can be let loose to perform them unsupervised with reliable results. Meanwhile, the WHO and UNAIDS have endorsed the procedure and suggested affected high HIV prevalence countries take it up. And now we get further reports that Africa is “hemorrhaging” doctors and nurses and thereby exacerbating the HIV/AIDS epidemic. Talk about putting the cart before the horse!

The unspeakable truth that nobody wants to discuss is that the circumcision trials were all about American researchers justifying their existence and perpetuating male circumcision in the United States at a time of its decline here rather than about Africa’s fight against HIV/AIDS. Given the choice between lifesaving condoms and male circumcision from inexperienced, overworked, sick medical staff who may not be doctors PLUS lifesaving condoms, any sane person (which Africans are implicitly not so considered) would choose the condoms and forgo the circumcision.

It’s politics as usual.

Download the Healthcare_Worker_Report_05-2007.pdf. Read the IRIN story, next page.

SOUTHERN AFRICA: Health staff haemorrhage limits AIDS treatment access

New MSF report says health staff shortages is threatening AIDS treatment efforts

JOHANNESBURG, 24 May 2007 (PlusNews) – A severe lack of healthcare workers is compromising both quality and availability of HIV/AIDS care in southern Africa, warned international medical relief organisation Medecins Sans Frontieres (MSF) on Thursday.

In a new report exploring the situation in Lesotho, Malawi, Mozambique and South Africa, MSF said more than 1 million people were in need of antiretroviral (ARV) drugs in each of these countries but could not access them.

Rachel Cohen, the MSF head of mission in Lesotho, attributed part of the problem to treatment expansion efforts in the region, which was leading to staff migration to countries that offered better pay and more manageable workloads.

“In Lesotho for example, there are just 89 doctors, 80 percent of whom are foreigners from other African countries awaiting certification in South Africa for better salaries,” she told IRIN/PlusNews.

According to the report, the shortage of doctors – less than 2 per 100,000 patients – made lower cadres such as nursing staff even more valuable in the provision of care, but they were also in short supply.

“As of May 2007, 54 percent of professional nursing posts at health centres were [vacant],” the study noted.

Lesotho not only has the third highest HIV prevalence in the world, with 23.2 percent of its 1.8 million population is HIV-positive, but the small mountainous kingdom is also ranked the 149th poorest country out of 170.

MSF head of mission for South Africa, Dr Eric Goemaere, said that restrictive donor financing was not helping the situation. “Despite wide acknowledgement by donors of the crisis, they are unwilling to cover ‘recurrent costs’ of health staff salaries. Instead they build more clinics with no staff to manage them.”

He added: “HIV-positive people do not only need drugs and clinics; they need trained, motivated health care workers to diagnose, monitor and care for them … current donor participation is equivalent to arranging chairs on the Titanic as it sinks.”

Veronica Chifaka, a nurse/matron working with MSF in the Malawi, told IRIN/PlusNews: “The vacancy rate for nurses in rural areas is 60 percent. Our treatment programme is hitting a wall because there is simply not enough nurses, doctors and medical assistants … the few staff that we do have at our disposal are not only overwhelmed by the workload, but are also dying of AIDS-related illnesses themselves.”

Even in South Africa, which has better paid healthcare workers than most other southern African countries, unequal distribution and inadequate numbers of staff was causing delays in expanding treatment.


Staff reports. SOUTHERN AFRICA: Health staff haemorrage limits AIDS treatment access. IRIN. May 24, 2007.

About David Wilton

fronterizo, public defender, intactivist, gay
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